Provider Notice Issued 10/30/2017

Re:Succeeding in the New Managed Care Program Series (#1): What is my relationship with health plans that weren’t awarded a contract for the new program?

This is the first in a series of notices to help providers succeed with the upcoming enhancement of the Managed Care Program at the Department of Healthcare and Family Services (HFS).

The new Managed Care Program is named “HealthChoice Illinois.”

Beginning on January 1, 2018, newly selected health plans under HealthChoice Illinois will have a contract to begin managing Medicaid client care in every Illinois County (Overview Notice), phased-in according to the program expansion mail schedule. Upgrades built into the program will also help providers participate more easily.

Exiting Plans: Responsibilities Continue

Providers should know that those health plans that will not be part of HealthChoice Illinois are required to meet all their contractual and financial obligations, including to their providers, throughout the upcoming transitional period.

Health plans exiting the FHP/ACA, ICP, and MLTSS programs on December 31, 2017 are: Aetna Better Health, Community Care Alliance, Family Health Network and Humana Health Plan. Cigna-HealthSpring is exiting MMAI on December 31, 2017.Exiting health plans are required to ensure care for their clients through 11:59pm, December 31, 2017. The announcement of HealthChoice Illinois does not change current relationships or health plan responsibilities.

Exiting health plans will also need to pay all verified claims, including any bills that remain outstanding after December 31, 2017. To facilitate resolution of any contractual liabilities throughout the transition, the Department has retained an independent auditing firm to work with the plans and providers. More details about this and other program aspects will be coming soon.

Understanding More

Articles in the Department’s Succeeding in the New Managed Care series:

#1. What is my relationship with plans that weren’t awarded a contract for the new program?

#2. Five key ways the new managed care will mean less work for providers

#3. Simplified credentialing: Cutting back on provider overhead costs

#4. How HFS and the health plans will communicate transition details to clients

#5. How you can help your patients understand what they need to know about this